Malawi

The weighted heat pressed down on my shoulders, and swirls of dust licked at my skin. I walked into the compounds of the hospital, the brilliant lavender of the jacaranda trees adding colour to the hot, blue sky. Everything else felt and looked hazy: the streets, the air, the myriad thoughts that swarmed through my head. I was in Malawi, some nearly 15,000 km from home, and here I’d be for close to two months.

Approaching the eye hospital, I saw a quilt of material on the lawn, a patchwork of the shirts and dresses that belonged to the patients staying in the wards. Freshly cleaned using soapy water in plastic buckets, the clothing was spread out to dry in the sun.

As I entered through reception, I made eye contact with several young mothers and smiled in greeting. Some of them returned a warm smile and laugh through our gaping lack of common language. They thrust their children forward and pointed to my camera.

Without speaking any Chichewa, I understood: “Take a photo.” I did, and enormous smiles and raucous laughter erupted upon viewing the image.

Some of these young women, touting small screaming children on their backs wrapped with vibrant chitenges, looked at me with stunned expressions. When I saw the children, a pit dropped in my stomach. Nasty eye infections, retinoblastoma, and cancerous growths looked back at me. I wondered what I could possibly do.

Days at the hospital quickly became routine. I spent many hours peering through slit lamp oculars. There were cataracts, geographic corneal ulcers, cases of allergic keratitis completely devastating the cornea due to a positive HIV diagnosis, and more traumatic eye injuries than I could count.

Well, I was in Africa, land of animals such as lions, elephants, warthogs, and yes, zebras. I was seeing zebras, indeed.

At home, in a Canadian setting, we say, “When you hear hoofbeats, think of horses.” This is to say, don’t think of zebras, an uncommon animal (or diagnosis), but think of the condition more likely to present in that circumstance. Well, I was in Africa, land of animals such as lions, elephants, warthogs, and yes, zebras. I was seeing zebras, indeed. All of these ocular conditions were not like anything I’d have seen at home; the way HIV prevented a person from healing, the way a patient must be essentially blind before being able to undergo cataract surgery, the ocular trauma from knife attacks, the neglected bacterial infections and the ringworm infections. This was normal to see in Malawi.

One day, I watched cataract surgery in the hospital’s operating theatre. After putting on scrubs, surgical foot and hair coverings, I was allowed inside. There were four beds side by side, a patient on each one, and at least one surgeon and a surgeon-in-training at each bed. I had observed cataract surgery in North America only a couple of months prior. There, I was appropriately attired and sat well out of the way. In Malawi, I was directly next to the surgeon and the patient undergoing the procedure. I could hear the clink of the metal instruments against the tray as they were passed hand-to-hand. I could hear the mutterings of the surgeon to the assistant. I could see the trainee’s perspiration and sense the strain and concentration.

In nearly two months in Africa, I had become accustomed to the daily power cuts, loss in water, and the more than spotty wifi. Even though a power cut schedule was printed in the newspaper, these outages were largely unpredictable. Imagine trying to perform ocular surgery in such an environment. Along with the price tag of modern phacoemulsification technology, this meant that the skilled surgeons used a much more rudimentary form of surgery.

At the end of each day, I always wondered what good or what difference I could possibly make in a place like Malawi

I watched closely as they snipped through the superior bulbar conjunctiva to expose the sclera. They anchored the eye by threading a needle with string through the conjunctiva and fastening it to a clip against the sheet covering the patient’s face. They made a large scleral incision and another corneal, and proceeded to work away at removing the lens with an instrument that looked like a little metal loop. In most cases, the lens was so dense that it just popped out in one piece with the loop. In some instances, more effort was involved with removing lens fragments, and it was not uncommon for complications to occur during surgery. Given the great skill involved, the lack of precise modern technology and the fact that there were trainees involved, more than once did a more senior surgeon have to step in to save the day… and the eye.

At the end of each day, I always wondered what good or what difference I could possibly make in a place like Malawi, a part of the world faced with the struggles of any developing nation. Ultimately, I decided that it was not naïve to conclude there was very little I could do as an individual. Be the change you want to see in the world. Sure, I can attempt that, but with the challenges and uncertainty of working in a country like Malawi, it’s hard to really see oneself as the change one wishes to see.

Sometimes all a person can do is see the constants in the uncertainty. In Malawi, that meant learning, constant learning.

And a smile. The warm heart of Africa, as Malawi is known, never let me down there. From the lovely young mothers at the hospital, to the strangers who greeted me in the market or waved to me from a minibus, and to the children who chased me to down just so they could sing and dance around me, Malawi was consistent and predictable there.

For a country that deals with these zebras, these advanced and devastating disease processes, a country where much is unpredictable, a country that is greatly impoverished, Malawi is rich in the warmth of its people and their easy smiles.

What I could definitely do is smile back. For the moment, for the change that I can realistically impart, that is enough.

The author chose to be anonymous, but we thank them for this great insight into a world many of us may never see.